RSV-specific binding molecule

ABSTRACT

The invention provides antibodies and functional equivalents thereof which are capable of specifically binding RSV. Nucleic acid sequences encoding said antibody, as well as antibody producing cells and methods for producing said antibody are also provided.

This application is a continuation patent application of U.S. patent application Ser. No. 14/039,148, filed on Sep. 27, 2013, which is a continuation patent application of U.S. patent application Ser. No. 12/898,325, filed on Oct. 5, 2010, which claims priority to U.S. Provisional Patent Application No. 61/278,358, filed Oct. 6, 2009, each of which is incorporated herein by reference.

SEQUENCE LISTING

This application contains a Sequence Listing electronically submitted to the United States Patent and Trademark Office via EFS-Web as an ASCH text file entitled “490-00020103_SequenceListing_ST25.txt” having a size of 16 kilobytes and created on Jan. 22, 2016. Due to the electronic filing of the Sequence Listing, the electronically submitted Sequence Listing serves as both the paper copy required by 37 CFR § 1.821(c) and the CRF required by § 1.821(e). The information contained in the Sequence Listing is incorporated by reference herein.

The Invention Relates to the Fields of Biology and Medicine

Respiratory Syncytial Virus (RSV) is a common cold virus belonging to the family of paramyxovirus. RSV is virulent, easily transmissible and the most common cause of lower respiratory tract disease in children of less than 2 years of age. Up to 98% of children attending day care will be infected in a single RSV season. Between 0.5% and 3.2% of children with RSV infection require hospitalization. Approximately 90,000 hospital admissions and 4500 deaths per year were reported in United States. Major risk factors for hospitalization due to RSV are premature birth, chronic lung disease, congenital heart disease, compromised immunity, and age younger than 6 weeks in otherwise healthy children. No effective treatment of RSV positive bronchiolitis beside supportive care in the form of adequate nutrition and oxygen therapy is available. Antiviral therapies such as Ribavirin have not been proven to be effective in RSV infection. One monoclonal antibody, palivizumab (also called Synagis), is registered for prophylaxis against RSV infection. Palivizumab is a genetically engineered (humanized) monoclonal antibody to the fusion protein (F protein) of RSV. The F protein of RSV is a viral membrane protein and responsible for fusion of the virion with a host cell after attachment. In addition, infection of neighboring cells through the formation of syncytia is promoted by the F protein and its function is thought to depend on the original oligomeric structure of the protein. However, palivizumab is not always effective. Therefore, there is a need in the art for alternative and/or supplementary antibodies and therapies against RSV.

It is an object of the invention to provide improved antibodies against RSV, or functional equivalents of such antibodies. It is a further object to provide supplementary antibodies against RSV, which, in combination with existing RSV-specific antibodies, provide a synergistic effect. It is a further object of the invention to provide human or humanized antibodies or functional equivalents against the RSV F protein which are directed against an epitope that is different from the epitopes that known RSV-specific antibodies are directed against.

Accordingly, the present invention provides an isolated, synthetic or recombinant antibody or a functional part, derivative and/or analogue thereof which is capable of specifically binding Respiratory Syncytial Virus and which comprises:

-   -   a heavy chain CDR1 sequence comprising a sequence which is at         least 70% identical to the sequence KLSIH (SEQ ID NO:4), and/or     -   a heavy chain CDR2 sequence comprising a sequence which is at         least 70% identical to the sequence GYEGEVDEIFYAQKFQH (SEQ ID         NO:8), and/or     -   a heavy chain CDR3 sequence comprising a sequence which is at         least 70% identical to the sequence LGVTVTEAGLGIDDY (SEQ ID NO:         12), and/or     -   a light chain CDR1 sequence comprising a sequence which is at         least 70% identical to the sequence RASQIVSRNHLA (SEQ ID NO:20),         and/or     -   a light chain CDR2 sequence comprising a sequence which is at         least 70% identical to the sequence GASSRAT (SEQ ID NO:24),         and/or     -   a light chain CDR3 sequence comprising a sequence which is at         least 70% identical to the sequence LSSDSSI (SEQ ID NO:28).

The present invention provides an antibody designated “AM22”, which has heavy chain and light chain sequences as depicted in FIG. 2. The CDR sequences of AM22, which in particular contribute to the antigen-binding properties of AM22, are also depicted in FIG. 2. Antibody AM22 is fully human, is capable of specifically binding RSV (FIG. 3) and is therefore preferred for prophylactic and/or therapeutic use for human individuals.

As mentioned above the only available clinically used anti-RSV antibody is palivizumab. This is a humanized monoclonal antibody directed against an epitope in the antigenic site of the F protein of RSV. Humanized antibodies still contain part of a mouse antibody and although immunogenic properties are diminished as compared to fully mouse antibodies, side-effects of humanized antibodies may occur when applied in humans. The present inventors, however, succeeded in obtaining and culturing human B-cells producing RSV-specific antibodies, so that human RSV-specific antibodies have been provided, that have strongly reduced—if at all—immunogenic activity as a result of the completely human sequence. As shown in the examples, antibodies according to the invention have superior characteristics as compared to palivizumab (FIG. 1 and table 1). The present inventors have shown that Cotton rats (Sigmodon hispidus) given antibodies according to the invention by intramuscular injection followed by intranasal challenge with RSV-X have a lower Pathology Index than Cotton rats given palivizumab followed by challenge with RSV-X (FIG. 4C and table 2). The Pathology Index used herein is a sum of scores to classify three individual markers for lung damage. These three markers are hyperthropy of bronchus and bronchioli epithelium, inflammation surrounding bronchus and bronchioli (peribronch(iol)itis) and inflammation in the alveoli (alveolitis). In addition, Cotton rats injected intramuscularly with antibodies according to the invention and subsequent RSV-X challenge had lower lung virus titers than Cotton rats given palivizumab followed by challenge with RSV-X (FIG. 4B), which was determined by TCID50 (50% tissue culture infective dose) assay. Hence, AM22 is preferred over palivizumab.

Besides palivizumab, some other RSV-specific antibodies are known. WO 2008/147196 discloses sequences of RSV binding molecules, namely antibodies D25, AM14, AM16 and AM23. As described in detail in example 1 of the current application, RSV specific antibody AM22 was obtained from the same donor as antibodies D25, AM14, AM16 and AM23. Strikingly however, AM22 recognizes RSV more efficiently than all other antibodies obtained from the same donor. The IC₅₀ value of AM22, 1.15 ng ml⁻¹, is lower than that of palivizumab, D25, AM14, AM16 or AM23. Therefore, the use of AM22 for treatment and/or prevention of a RSV-related disorder has advantages over the use of other RSV specific antibodies. Less AM22 antibody is necessary to obtain a similar effect compared to the other antibodies. Therefore, less AM22 has to be administered to an individual for treatment and/or prevention of a RSV-related disorder. Alternatively, with a similar amount of AM22, as compared to the other antibodies, a more effective treatment and/or prevention of a RSV-related disorder is achieved.

Furthermore, an RSV-specific antibody according to the present invention recognizes a different epitope as the previously disclosed RSV binding molecules. AM22, similar to the previously identified antibodies (WO2008/147196), is capable of binding the RSV F protein (FIG. 3A). However, AM22 does not bind a monomeric RSV F protein (FIG. 3B left and right panel). Contrary to AM22, the known antibodies palivizumab and AM16 (disclosed in WO 2008/147196 and FIG. 3B) are capable of binding the monomeric form of the F protein. Importantly the AM22 B cell line, expressing the antigen specific B Cell Receptor (BCR) does not recognize a recombinant form of the F protein (FIG. 3C). Thus AM22 binds a different epitope of the F protein than palivizumab, D25, AM23 and AMI6. When the recombinant F protein was expressed in a vector containing an isoleucine zipper trimerization motif with eight HIS-tags (ILZ-8×HIS), then AM22 recognized this trimeric, conformation dependent structure (FIG. 3D). In contrast AM14 did not recognize either the monomeric form of the F protein or the ILZ-8×HIS F protein. Thus AM22 binds a different epitope of the F protein than AM14 as well. Furthermore it was found that AM22 did not interfere with D25 or palivizumab binding to RSV infected Hep2 cells. Thus, AM22 binds a different epitope of the F protein as compared to D25, AM14, AM16, AM23 and palivizumab. Therefore, RSV-specific antibodies or functional equivalents thereof according to the present invention are preferably combined with RSV-specific antibodies that are already known, such as palivizumab, D25, AM14, AM16 and AM23. By combining an antibody according to the invention with a known RSV-specific antibody, two or more different epitopes of RSV are recognized during the same therapy. This way, a stronger immunogenic response to RSV is obtained. Furthermore, higher antibody specificity against RSV is reached by combining one of the known RSV-specific antibodies with an AM22 antibody according to the invention. With a stronger immunogenic response to and higher specificity against RSV, such combination will result in more effective treatment and/or prevention of a RSV-related disorder. Finally, a lower overall antibody dosage is needed because AM22 has a stronger binding capacity for the F protein compared to palivizumab, D25, AM14, AM16 and AM23, as demonstrated by its low IC₅₀ value, of about 1.15 ng/ml.

One embodiment therefore provides an antibody or functional equivalent according to the invention which has an IC₅₀ value less than 1.25 ng/ml in an in vitro neutralization assay wherein HEp-2 cells are infected with RSV-A2 virus. Said antibody or functional equivalent preferably has an IC₅₀ value of less than 1.2 ng/ml, preferably between 0.5 ng/ml and 1.2 ng/ml. Additionally, an antibody or functional equivalent according to the invention preferably has an IC₅₀ value which is at least 120-fold lower, more preferably at least 130-fold lower, than the IC₅₀ value of palivizumab in an in vitro neutralization assay wherein HEp-2 cells are infected with RSV-A2 virus. Said antibody or functional equivalent preferably has an IC₅₀ value of about 1.15 ng/ml. Thus with an RSV-specific antibody or functional equivalent thereof according to the present invention in combination with at least one available RSV-specific antibody a more effective treatment and/or prevention of a RSV-related disorder is achieved.

A functional equivalent of an antibody is defined herein as a functional part, derivative or analogue of an antibody. A functional equivalent of an antibody is preferably an artificial binding compound, comprising at least one CDR sequence of an antibody.

A functional part of an antibody is defined as a part which has at least one same property as said antibody in kind, not necessarily in amount. Said functional part is capable of binding the same antigen as said antibody, albeit not necessarily to the same extent. A functional part of an antibody preferably comprises a single domain antibody, a single chain antibody, a single chain variable fragment (scFv), a Fab fragment or a F(ab′)₂ fragment.

A functional derivative of an antibody is defined as an antibody which has been altered such that at least one property—preferably an antigen-binding property—of the resulting compound is essentially the same in kind, not necessarily in amount. A derivative is provided in many ways, for instance through conservative amino acid substitution, whereby an amino acid residue is substituted by another residue with generally similar properties (size, hydrophobicity, etc), such that the overall functioning is likely not to be seriously affected.

A person skilled in the art is well able to generate analogous compounds of an antibody. This is for instance done using a peptide library or phage display library. Such an analogue has essentially at least one same property as said antibody in kind, not necessarily in amount.

An antibody according to the invention is preferably a human antibody. The use of human antibodies for prophylaxis and therapy in humans diminishes the chance of side-effects due to an immunological reaction in a human individual against non-human sequences. In another embodiment an antibody, functional part, derivative or analogue according to the invention is a humanized antibody. Humanized antibodies are made by incorporating non-human hypervariable domains into human antibodies and therefore immunogenic properties are diminished as compared to fully non-human antibodies. In another preferred embodiment an antibody or functional part, derivative or analogue according to the invention is a chimeric antibody. This way, sequences of interest, such as for instance a binding site of interest, can be included into an antibody or functional equivalent according to the invention.

As is well known by the skilled person, a heavy chain of an antibody is the larger of the two types of chains making up an immunoglobulin molecule. A heavy chain comprises constant domains and a variable domain, which variable domain is involved in antigen binding. A light chain of an antibody is the smaller of the two types of chains making up an immunoglobulin molecule. A light chain comprises a constant domain and a variable domain. The variable domain is, together with the variable domain of the heavy chain, involved in antigen binding.

Complementary-determining regions (CDRs) are the hypervariable regions present in heavy chain variable domains and light chain variable domains. The CDRs of a heavy chain and the connected light chain of an antibody together form the antigen-binding site.

Now that the present invention provides the insight that the CDR sequences depicted in FIG. 2 provide desired binding characteristics, a skilled person is well capable of generating variants comprising at least one altered CDR sequence. For instance, conservative amino acid substitution is applied. It is also possible to alter at least one CDR sequence depicted in FIG. 2 in order to generate a variant antibody, or a functional equivalent thereof, with at least one altered property as compared to AM22. Preferably, an antibody or functional equivalent is provided comprising a CDR sequence which is at least 70% identical to a CDR sequence as depicted in FIG. 2, so that the favorable binding characteristics of AM22 are at least in part maintained or even improved. A CDR sequence as depicted in FIG. 2 is preferably altered such that the resulting antibody or functional equivalent comprises at least one improved property, such as for instance an improved stability and/or binding affinity, as compared to AM22. The binding specificity is preferably maintained (in kind, not necessarily in amount). Variant antibodies or functional equivalents thereof comprising an amino acid sequence which is at least 70% identical to a CDR sequence as depicted in FIG. 2 are therefore also within the scope of the present invention. Various methods are available in the art for altering an amino acid sequence. For instance, a heavy chain or light chain sequence with a desired CDR sequence is artificially synthesized. Preferably, a nucleic acid sequence encoding a CDR sequence is mutated, for instance using random—or site-directed—mutagenesis.

Measurement of the affinity constant and specificity of binding between antigen and antibody is preferred in determining the efficacy of prophylactic, therapeutic, diagnostic and research methods using anti-RSV antibodies of the invention. “Binding affinity” generally refers to the strength of the sum total of the noncovalent interactions between a single binding site of a molecule (e.g., an antibody) and its binding partner (e.g., an antigen). Unless indicated otherwise, as used herein, “binding affinity” refers to intrinsic binding affinity which reflects a 1:1 interaction between members of a binding pair (e.g., antibody and antigen). The affinity can generally be represented by the equilibrium dissociation constant (Kd), which is calculated as the ratio k_(off)/k_(on). See, e.g., Chen, Y., et al., (1999) J. Mol Biol 293:865-881. Affinity can be measured by common methods known in the art, such as for instance a surface plasmon resonance (SPR) assay such as BiaCore or IBIS-iSPR instrument at IBIS Technologies BV (Hengelo, the Netherlands) or solution phase assays, such as Kinexa.

According to preferred embodiments, the present anti-RSV antibodies of the invention have binding affinities for an epitope on the RSV F protein that include a dissociation constant (K_(d)) of less than 1×10⁻² M, 1×10⁻³ M, 1×10⁻⁴ M, 1×10⁻⁵ M, 1×10⁻⁶ M, 1×10⁻⁷ M, 1×10⁻⁸ M, 1×10⁻⁹ M, 1×10⁻¹⁰ M, 1×10⁻¹¹ M, 1×10⁻¹² M, 1×10⁻¹³ M, 1×10⁻¹⁴ M or less than 1×10⁻¹⁵ M. In one embodiment, the anti-RSV antibodies have a K_(d) of less than 10⁻⁷ M, less than 5×10⁻⁸ M, less than 10⁻⁸ M, less than 5×10⁻⁹ M, less than 10⁻⁹ M, less than 5×10⁻¹⁰ M, less than 10⁻¹⁰ M, less than 5×10⁻¹¹ M, less than 10⁻¹¹ M, less than 5×10⁻¹² M, less than 10⁻¹² M, less than 5×10⁻¹³ M, less than 10⁻¹³ M, less than 5×10⁻¹⁴ M, less than 10⁻¹⁴ M, less than 5×10⁻¹⁵ M, or less than 10⁻¹⁵ M.

The invention further provides an isolated, synthetic or recombinant antibody or a functional part, derivative and/or analogue thereof, which comprises:

-   -   a heavy chain CDR1 sequence comprising a sequence which has at         least 70% sequence identity to the sequence KLSIH (SEQ ID NO:         4), and/or     -   a heavy chain CDR2 sequence comprising a sequence which has at         least 70% sequence identity to the sequence GYEGEVDEIFYAQKFQH         (SEQ ID NO: 8), and/or     -   a heavy chain CDR3 sequence comprising a sequence which has at         least 70% sequence identity to the sequence LGVTVTEAGLGIDDY (SEQ         ID NO: 12) and/or     -   a light chain CDR1 sequence comprising a sequence which is at         least 70% identical to the sequence RASQIVSRNHLA (SEQ ID NO:         20), and/or     -   a light chain CDR2 sequence comprising a sequence which is at         least 70% identical to the sequence GASSRAT (SEQ ID NO: 24),         and/or     -   a light chain CDR3 sequence comprising a sequence which is at         least 70% identical to the sequence LSSDSSI (SEQ ID NO: 28).

Preferably, an antibody or functional equivalent according to the invention comprises a CDR sequence which is at least 75%, more preferably at least 80%, more preferably at least 85%, more preferably at least 90% identical to at least one of the CDR sequences depicted in FIG. 2. Most preferably, an antibody or functional equivalent according to the invention comprises a CDR sequence which is at least 95% identical to at least one of the CDR sequences depicted in FIG. 2. The particularly preferred antibody AM22, described above, comprises CDR sequences which consist of the CDR sequences depicted in FIG. 2. A particularly preferred embodiment according to the invention thus provides an isolated, synthetic or recombinant antibody or a functional equivalent thereof which is capable of specifically binding RSV and which comprises:

-   -   a heavy chain CDR1 sequence comprising the sequence KLSIH (SEQ         ID NO: 4), and/or     -   a heavy chain CDR2 sequence comprising the sequence         GYEGEVDEIFYAQKFQH (SEQ ID NO: 8), and/or     -   a heavy chain CDR3 sequence comprising the sequence         LGVTVTEAGLGIDDY (SEQ ID NO: 12), and/or     -   a light chain CDR1 sequence comprising the sequence RASQIVSRNHLA         (SEQ ID NO: 20), and/or     -   a light chain CDR2 sequence comprising the sequence GASSRAT (SEQ         ID NO: 24), and/or     -   a light chain CDR3 sequence comprising the sequence LSSDSSI (SEQ         ID NO: 28).

In one embodiment an antibody or functional equivalent is provided which comprises the heavy chain CDR1 and CDR2 sequences and the light chain CDR1 and CDR2 sequences as depicted in FIG. 2, or sequences that are at least 70%, preferably at least 75%, more preferably at least 80%, more preferably at least 85% identical thereto. Further provided is therefore an isolated, synthetic or recombinant antibody or a functional part, derivative and/or analogue thereof which comprises a heavy chain CDR1 sequence comprising a sequence which is at least 70% identical to the sequence KLSIH (SEQ ID NO: 4) and a heavy chain CDR2 sequence comprising a sequence which is at least 70% identical to the sequence GYEGEVDEIFYAQKFQH (SEQ ID NO: 8) and a light chain CDR1 sequence comprising a sequence which is at least 70% identical to the sequence RASQIVSRNHLA (SEQ ID NO: 20) and a light chain CDR2 sequence comprising a sequence which is at least 70% identical to the sequence GASSRAT (SEQ ID NO: 24). Said antibody or functional equivalent preferably comprises CDR sequences which are at least 75%, more preferably at least 80%, more preferably at least 85%, more preferably at least 90%, most preferably at least 95% identical to the above mentioned heavy chain CDR sequences and light chain CDR sequences. Preferably, said antibody or functional equivalent also comprises a heavy chain CDR3 sequence comprising a sequence which is at least 70% identical to the sequence LGVTVTEAGLGIDDY (SEQ ID NO: 12), and/or a light chain CDR3 sequence comprising a sequence which is at least 70% identical to the sequence LSSDSSI (SEQ ID NO: 28). An antibody or functional equivalent comprising the above mentioned heavy chain CDR1, CDR2 and CDR3 sequences as well as the above mentioned light chain CDR1, CDR2 and CDR3 sequences is also provided.

Optionally, said at least one human CDR sequence is optimized, preferably in order to improve binding efficacy or stability. This is for instance done by mutagenesis experiments where after the stability and/or binding efficacy of the resulting compounds are preferably tested and an improved antibody or functional equivalent is selected.

Besides optimizing CDR sequences, it is often advantageous to optimize at least one sequence in at least one of the frame work regions. This is preferably done in order to improve binding efficacy or stability. Frame work sequences are for instance optimized by mutating a nucleic acid molecule encoding such frame work sequence where after the characteristics of the resulting antibody—or functional part—is preferably tested. This way, it is possible to obtain improved antibodies or functional parts. Isolated, synthetic or recombinant antibodies or functional parts, derivatives and/or analogues thereof comprising a heavy chain amino acid sequence which has at least 70% sequence identity to the heavy chain sequence as depicted in FIG. 2 are therefore also provided. Such heavy chain sequence provides desired binding properties, as evidenced by antibody AM22. Moreover, light chain amino acid sequences which have at least 70% sequence identity to the light chain sequence as depicted in FIG. 2 also provide desired binding properties, as evidenced by antibody AM22. Further provided is therefore an isolated, synthetic or recombinant antibody or a functional part, derivative and/or analogue thereof according to the invention, having a heavy chain sequence comprising a sequence which has at least 70% sequence identity to the sequence

(SEQ ID NO: 16) QVQLVQSGAEVKKPGATVKVSCKISGHTLIKLSIHWVRQAPGKGLEWMGG YEGEVDEIFYAQKFQHRLTVIADTATDTVYMELGRLTSDDTAVYFCGTLG VTVTEAGLGIDDYWGQGTLVTVSS and/or having a light chain sequence which has at least 70% sequence identity to the sequence

(SEQ ID NO: 32) EIVLTQSPGTLSLSPGERATLSCRASQIVSRNHLAWYQQKPGQAPRLLIF GASSRATGIPVRFSGSGSGTDFTLTINGLAPEDFAVYYCLSSDSSIFTFG PGTKVDFK.

An isolated, synthetic or recombinant antibody or a functional part, derivative and/or analogue thereof according to the invention preferably comprises a heavy chain sequence and/or a light chain sequence which is at least 75%, more preferably at least 80%, more preferably at least 85%, more preferably at least 90%, most preferably at least 95% identical to a heavy chain sequence and/or a light chain sequence as depicted in FIG. 2. The higher the homology, the more closely said antibody or functional equivalent resembles antibody AM22. An isolated, synthetic or recombinant antibody or a functional part, derivative and/or analogue thereof according to the invention preferably comprises a heavy chain as well as a light chain which resemble the heavy and light chain of AM22. Further provided is therefore an isolated, synthetic or recombinant antibody or a functional part, derivative and/or analogue thereof comprising a heavy chain sequence and a light chain sequence which are at least 70%, more preferably at least 80%, more preferably at least 85%, more preferably at least 90%, most preferably at least 95% identical to the heavy chain sequence and the light chain sequence, respectively, as depicted in FIG. 2. In one embodiment an antibody or functional equivalent is provided which has a heavy chain sequence as depicted in FIG. 2 and a light chain sequence as depicted in FIG. 2.

One embodiment provides an isolated, synthetic or recombinant antibody or a functional part, derivative and/or analogue thereof comprising a heavy chain sequence consisting of the heavy chain sequence as depicted in FIG. 2, and/or comprising a light chain sequence consisting of the light chain sequence as depicted in FIG. 2. Alternatively, as is well known by the skilled person, it is possible to generate a shortened heavy chain or light chain sequence while maintaining a binding property of interest. Preferably, such a shortened heavy chain or light chain is generated which has a shorter constant region, as compared to the original heavy or light chain. The variable domain is preferably maintained. For instance, a Fab fragment or F(ab′)₂ fragment or a single domain antibody or a single chain antibody or a nanobody or an unibody or a scFv fragment based on a heavy chain sequence or light chain sequence depicted in FIG. 2 is produced. A functional part of an antibody comprising at least a functional part of a sequence as depicted in FIG. 2 is therefore also provided. Said functional part has a length of at least 20 amino acids and comprises at least one sequence selected from the group consisting of a sequence which is at least 70% identical to the heavy chain CDR1 sequence depicted in FIG. 2 and a sequence which has at least 70% sequence identity to the heavy chain CDR2 sequence depicted in FIG. 2 and a sequence which has at least 70% sequence identity to the heavy chain CDR3 sequence depicted in FIG. 2 and a sequence which has at least 70% sequence identity to the light chain CDR1 sequence depicted in FIG. 2 and a sequence which has at least 70% sequence identity to the light chain CDR2 sequence depicted in FIG. 2 and a sequence which has at least 70% sequence identity to the light chain CDR3 sequence depicted in FIG. 2.

As said before, antibodies and functional equivalents according to the present invention recognize a unique epitope of an RSV F protein trimer. Hence, antibodies and functional equivalents are provided that specifically recognize this epitope. Antibodies or functional equivalents thereof that specifically recognize said unique epitope are preferably combined with RSV-specific antibodies that are already known, such as palivizumab, D25, AM14, AM16 and AM23. By combining an antibody or functional equivalent according to the invention that specifically recognizes said unique epitope with a known RSV-specific antibody, two or more different epitopes of RSV are recognized during the same therapy. This way, a stronger immunogenic response to RSV and/or a higher antibody specificity against RSV is reached With a stronger immunogenic response to and higher specificity against RSV, such combination will result in more effective treatment and/or prevention of a RSV-related disorder.

Therefore, the invention provides an isolated, synthetic or recombinant antibody or a functional part, derivative and/or analogue thereof which is capable of specifically binding an epitope that is recognized by an antibody which comprises:

-   -   a heavy chain CDR1 sequence comprising the sequence KLSIH (SEQ         ID NO: 4), and/or     -   a heavy chain CDR2 sequence comprising the sequence         GYEGEVDEIFYAQKFQH (SEQ ID NO: 8), and/or     -   a heavy chain CDR3 sequence comprising the sequence         LGVTVTEAGLGIDDY (SEQ ID NO: 12), and/or     -   a light chain CDR1 sequence comprising the sequence RASQIVSRNHLA         (SEQ ID NO: 20), and/or     -   a light chain CDR2 sequence comprising the sequence GASSRAT (SEQ         ID NO: 24), and/or     -   a light chain CDR3 sequence comprising the sequence LSSDSSI (SEQ         ID NO: 28).

In a particularly preferred embodiment the invention provides an isolated, synthetic or recombinant antibody or a functional part, derivative and/or analogue thereof which is capable of specifically binding an epitope that is recognized by an AM22 antibody which comprises:

-   -   a heavy chain CDR1 sequence comprising the sequence KLSIH (SEQ         ID NO: 4), and     -   a heavy chain CDR2 sequence comprising the sequence         GYEGEVDEIFYAQKFQH (SEQ ID NO: 8), and     -   a heavy chain CDR3 sequence comprising the sequence         LGVTVTEAGLGIDDY (SEQ ID NO: 12), and     -   a light chain CDR1 sequence comprising the sequence RASQIVSRNHLA         (SEQ ID NO: 20), and     -   a light chain CDR2 sequence comprising the sequence GASSRAT (SEQ         ID NO: 24), and     -   a light chain CDR3 sequence comprising the sequence LSSDSSI (SEQ         ID NO: 28).

A further embodiment of the invention contemplates certain antibody constant region (Fc) modifications to alter effector functions. For example, the serum half-life of proteins comprising Fc regions is increased by increasing the binding affinity of the Fc region for FcRn. The term “antibody half-life” as used herein means a pharmacokinetic property of an antibody that is a measure of the mean survival time of antibody molecules following their administration. Antibody half-life can be expressed as the time required to eliminate 50 percent of a known quantity of immunoglobulin from the patient's body (or other mammal) or a specific compartment thereof, for example, as measured in serum, i.e., circulating half-life, or in other tissues. Half-life may vary from one immunoglobulin or class of immunoglobulin to another. In general, an increase in antibody half-life results in an increase in mean residence time (MRT) in circulation for the antibody administered.

The increase in half-life allows for the reduction in amount of drug given to a patient as well as reducing the frequency of administration. To increase the serum half life of an antibody according to the invention, one may incorporate a salvage receptor binding epitope into the antibody (especially an antibody fragment) as described in U.S. Pat. No. 5,739,277, for example. As used herein, the term “salvage receptor binding epitope” refers to an epitope of the Fc region of an IgG molecule (e.g., IgG1, IgG2, IgG3, or IgG4) that is responsible for increasing the in vivo serum half-life of the IgG molecule. Alternatively, antibodies of the invention with increased half-lives may be generated by modifying amino acid residues identified as involved in the interaction between the Fc and an FcRn receptor (see, for examples, U.S. Pat. Nos. 6,821,505 and 7,083,784). In addition, the half-life of antibodies of the invention may be increased by conjugation to PEG or Albumin by techniques widely utilized in the art. In some embodiments antibodies comprising Fc variant regions of the invention have an increased half-life of about 5%, about 10%, about 15%, about 20%, about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about 60%, about 65%, about 70%, about 80%, about 85%, about 90%, about 95%, about 100%, about 125%, about 150% or more as compared to an antibody comprising a native Fc region. In some embodiments antibodies comprising Fc variant regions have an increased half-life of about 2 fold, about 3 fold, about 4 fold, about 5 fold, about 10 fold, about 20 fold, about 50 fold or more, or is between 2 fold and 10 fold, or between 5 fold and 25 fold, or between 15 fold and 50 fold, as compared to an antibody comprising a native Fc region. The invention therefore provides an antibody, functional part, derivative or analogue according the invention, comprising a salvage receptor binding epitope, and/or modified amino acid residues identified as involved in the interaction between the Fc and an FcRN receptor, and/or non naturally occurring amino acid residues. Another preferred embodiment provides an antibody or functional equivalent according to the invention which is conjugated to PEG or Albumin.

In one embodiment, the present invention provides Fc variants according to the invention, wherein the Fc region comprises a modification (e.g., amino acid substitution, amino acid insertion, amino acid deletion) at one or more positions selected from the group consisting of 234, 235, 236, 237, 238, 239, 240, 241, 243, 244, 245, 247, 251, 252, 254, 255, 256, 262, 263, 264, 265, 266, 267, 268, 269, 279, 280, 284, 292, 296, 297, 298, 299, 305, 313, 316, 325, 326, 327, 328, 329, 330, 331, 332, 333, 334, 339, 341, 343, 370, 373, 378, 392, 416, 419, 421, 440 and 443 as numbered by the EU index as set forth in Kabat et al (J Immunol. 1991; 147(5):1709-19). Optionally, the Fc region comprises a non naturally occurring amino acid residue at additional and/or alternative positions known to one skilled in the art (see, e.g., U.S. Pat. Nos. 5,624,821; 6,277,375; 6,737,056; 7,083,784; 7,317,091; 7,217,797; 7,276,585; 7,355,008; 2002/0147311; 2004/0002587; 2005/0215768; 2007/0135620; 2007/0224188; 2008/0089892; WO 94/29351; and WO 99/58572).

In a specific embodiment, the present invention provides an Fc variant antibody according to the invention, wherein the Fc region comprises at least one non-naturally occurring amino acid at one or more positions selected from the group consisting of 252, 254, and 256. In one embodiment, the non-naturally occurring amino acids are selected from the group consisting of 252Y, 254T and 256E.

The present invention provides RSV-specific antibodies and functional equivalents thereof having improved properties as compared to prior art antibodies. The inventors have succeeded in generating RSV-specific antibodies with the lowest IC₅₀ value currently known. Such antibodies have a particular high or strong affinity for RSV and are therefore particularly suitable for counteracting and/or at least in part preventing an RSV-infection and/or adverse effects of an RSV infection. One embodiment therefore provides an antibody which has an IC₅₀ value of less than 1.25 ng/ml, preferably less than 1.2 ng/ml, more preferably less that 1.19 ng/ml, more preferably less than 1.18 ng/ml, and most preferably between 1.1 ng/ml and 1.17 as determined in the in vitro neutralization assay described in the examples (see FIG. 1).

The invention further provides an isolated, synthetic or recombinant nucleic acid sequence or a functional equivalent thereof with a length of at least 15 nucleotides, preferably at least 30 nucleotides, more preferably at least 50 nucleotides, more preferably at least 75 nucleotides, encoding at least an antigen-binding part of an antibody or functional equivalent according to the invention. Such nucleic acid is for instance isolated from a B-cell which is capable of producing an antibody according to the invention. A preferred embodiment provides a nucleic acid sequence comprising a sequence which has at least 70% sequence identity to at least 15 nucleotides of a nucleic acid sequence as depicted in FIG. 2. A nucleic acid sequence according to the invention preferably comprises a sequence which has at least 75%, more preferably at least 80%, more preferably at least 85%, more preferably at least 90%, most preferably at least 95% sequence identity to at least 15 nucleotides of a nucleic acid sequence as depicted in FIG. 2. Preferably, said nucleic acid sequence as depicted in FIG. 2 comprises at least one CDR encoding sequence.

One preferred embodiment provides an isolated, synthetic or recombinant nucleic acid sequence with a length of at least 15 nucleotides, or a functional equivalent thereof, encoding at least one CDR sequence of an antibody or functional equivalent according to the invention. Said nucleic acid sequence preferably encodes at least one CDR sequence which has at least 70% sequence identity to a CDR region of antibody AM22. Nucleic acid sequences encoding AM22 CDR regions are depicted in FIG. 2. Further provided is therefore an isolated, synthetic or recombinant nucleic acid sequence, or a functional equivalent thereof, comprising a sequence which has at least 70% sequence identity to a sequence selected from the group consisting of aaattatccattcac (SEQ ID NO: 3), ggttatgagggtgaggtcgatgagattttctacgcacagaagttccagcac (SEQ ID NO: 7), ctaggtgtgacagtgactgaggctggactggggatcgatgactac (SEQ ID NO: 11), agggccagtcagattgttagcaggaaccacttagcc (SEQ ID NO: 19), ggtgcgtccagtcgggccact (SEQ ID NO: 23) and ctgtcctctgattcctccata (SEQ ID NO: 27).

Said nucleic acid sequence or functional equivalent preferably comprises a sequence which has at least 75%, more preferably at least 80%, more preferably at least 85%, more preferably at least 90% sequence identity to any of the above mentioned nucleic acid sequences. Further provided is a nucleic acid sequence or functional equivalent thereof comprising a sequence which has at least 70% sequence identity to at least part of a nucleotide sequence as depicted in FIG. 2, said part having at least 15 nucleotides and encoding at least one CDR region as depicted in FIG. 2.

A nucleic acid sequence or functional equivalent thereof according to the present invention preferably encodes a region which has at least 70% sequence identity to an AM22 CDR region, an AM22 heavy chain and/or an AM22 light chain. One embodiment thus provides an isolated, synthetic or recombinant nucleic acid sequence, or a functional equivalent thereof, comprising a sequence encoding an amino acid sequence which has at least 70% sequence identity to the sequence KLSIH (SEQ ID NO: 4), and/or at least 70% sequence identity to the sequence GYEGEVDEIFYAQKFQH (SEQ ID NO: 8), and/or at least 70% sequence identity to the sequence LGVTVTEAGLGIDDY (SEQ ID NO: 12), and/or at least 70% sequence identity to the sequence RASQIVSRNHLA (SEQ ID NO: 20), and/or at least 70% sequence identity to the sequence GASSRAT (SEQ ID NO: 24), and/or at least 70% sequence identity to the sequence LSSDSSI (SEQ ID NO: 28), and/or at least 70% sequence identity to the sequence

(SEQ ID NO: 16) QVQLVQSGAEVKKPGATVKVSCKISGHTLIKLSIHWVRQAPGKGLEWMGG YEGEVDEIFYAQKFQHRLTVIADTATDTVYMELGRLTSDDTAVYFCGTLG VTVTEAGLGIDDYWGQGTLVTVSS, and/or at least 70% sequence identity to the sequence

(SEQ ID NO: 32) EIVLTQSPGTLSLSPGERATLSCRASQIVSRNHLAWYQQKPGQAPRLLIF GASSRATGIPVRFSGSGSGTDFTLTINGLAPEDFAVYYCLSSDSSIFTFG PGTKVDFK.

As said before, an antibody or functional equivalent according to the invention is capable of recognizing a unique epitope present on trimeric RSV F proteins. A nucleic acid sequence according to the invention thus preferably encodes a CDR sequence capable of specifically binding this unique epitope. Also provided by the invention is therefore an isolated, synthetic or recombinant nucleic acid sequence or a functional equivalent thereof, encoding at least one CDR sequence capable of specifically binding an epitope that is recognized by an antibody which comprises:

-   -   a heavy chain CDR1 sequence comprising the sequence KLSIH (SEQ         ID NO: 4), and/or     -   a heavy chain CDR2 sequence comprising the sequence         GYEGEVDEIFYAQKFQH (SEQ ID NO: 8), and/or     -   a heavy chain CDR3 sequence comprising the sequence         LGVTVTEAGLGIDDY (SEQ ID NO: 12), and/or     -   a light chain CDR1 sequence comprising the sequence RASQIVSRNHLA         (SEQ ID NO: 20), and/or     -   a light chain CDR2 sequence comprising the sequence GASSRAT (SEQ         ID NO: 24), and/or     -   a light chain CDR3 sequence comprising the sequence LSSDSSI (SEQ         ID NO: 28).

Preferably, said nucleic acid sequence encodes a whole antibody or functional equivalent (for instance comprising a heavy chain or light chain) according to the invention. Further provided is therefore an isolated, synthetic or recombinant nucleic acid sequence, or a functional equivalent thereof, encoding an antibody or functional equivalent thereof capable of specifically binding an epitope that is recognized by an antibody which comprises:

-   -   a heavy chain CDR1 sequence comprising the sequence KLSIH (SEQ         ID NO: 4), and/or     -   a heavy chain CDR2 sequence comprising the sequence         GYEGEVDEIFYAQKFQH (SEQ ID NO: 8), and/or     -   a heavy chain CDR3 sequence comprising the sequence         LGVTVTEAGLGIDDY (SEQ ID NO: 12), and/or     -   a light chain CDR1 sequence comprising the sequence RASQIVSRNHLA         (SEQ ID NO: 20), and/or     -   a light chain CDR2 sequence comprising the sequence GASSRAT (SEQ         ID NO: 24), and/or     -   a light chain CDR3 sequence comprising the sequence LSSDSSI (SEQ         ID NO: 28).

In one embodiment of the invention a nucleic acid sequence or functional equivalent encodes an antibody or a functional part, derivative and/or analogue thereof capable of specifically binding an epitope that is recognized by an AM22 antibody, which comprises a heavy chain CDR1 sequence comprising the sequence KLSIH (SEQ ID NO: 4), and a heavy chain CDR2 sequence comprising the sequence GYEGEVDEIFYAQKFQH (SEQ ID NO: 8), and a heavy chain CDR3 sequence comprising the sequence LGVTVTEAGLGIDDY (SEQ ID NO: 12), and a light chain CDR1 sequence comprising the sequence RASQIVSRNHLA (SEQ ID NO: 20), and a light chain CDR2 sequence comprising the sequence GASSRAT (SEQ ID NO: 24), and a light chain CDR3 sequence comprising the sequence LSSDSSI (SEQ ID NO: 28).

A nucleic acid sequence or functional equivalent according to the invention preferably encodes an antibody or functional equivalent thereof that has a dissociation constant (K_(d)) of less than 1×10⁻² M, 1×10⁻³ M, 1×10⁻⁴ M, 1×10⁻⁵ M, 1×10⁻⁶ M, 1×10⁻⁷ M, 1×10⁻⁸ M, 1×10⁻⁹ M, 1×10⁻¹⁰ M, 1×10⁻¹¹ M, 1×10⁻¹² M, 1×10⁻¹³ M, 1×10⁻¹⁴M or less than 1×10⁻¹⁵ M.

Further provided is a vector comprising a nucleic acid sequence according to the invention. Such vector is suitable for a variety of applications. For instance, a vector of the invention comprising a therapeutically beneficial nucleic acid sequence is suitable for prophylactic or therapeutic applications. Administration of such vector to an individual in need thereof results in expression of said prophylactic or therapeutic nucleic acid sequence in vivo. Said vector can also be used in applications involving in vitro expression of a nucleic acid sequence of interest, for instance for (commercial) production of antibodies or functional equivalents according to the invention. Methods for constructing a vector with a nucleic acid sequence according to the invention are well known in the art. Non-limiting examples of vectors suitable for generating a vector of the invention are retroviral and lentiviral vectors.

The term “% sequence identity” is defined herein as the percentage of residues in a candidate amino acid sequence or candidate nucleic acid sequence that is identical with the residues in a reference sequence after aligning the two sequences and introducing gaps, if necessary, to achieve the maximum percent identity. Methods and computer programs for the alignment are well known in the art.

As used herein, a nucleic acid molecule or nucleic acid sequence of the invention preferably comprises a chain of nucleotides, more preferably DNA and/or RNA. In other embodiments a nucleic acid molecule or nucleic acid sequence of the invention comprises other kinds of nucleic acid structures such as for instance a DNA/RNA helix, peptide nucleic acid (PNA), locked nucleic acid (LNA) and/or a ribozyme. Such other nucleic acid structures are referred to as functional equivalents of a nucleic acid sequence. The term “functional equivalent of a nucleic acid sequence” also encompasses a chain comprising non-natural nucleotides, modified nucleotides and/or non-nucleotide building blocks which exhibit the same function as natural nucleotides.

A nucleic acid sequence or vector according to the present invention is particularly useful for generating antibodies or functional equivalents which are specific for RSV. This is for instance done by introducing such nucleic acid sequence or vector into a cell so that the cell's nucleic acid translation machinery will produce the encoded antibody or functional equivalent. In one embodiment, a nucleic acid sequence or vector encoding a heavy and/or light chain according to the invention is expressed in so called producer cells, such as for instance cells of a Chinese hamster ovary (CHO), NSO (a mouse myeloma) or 293(T) cell line, some of which are adapted to commercial antibody production. Proliferation of said producer cells results in a producer cell line capable of producing antibodies or functional equivalents thereof according to the present invention. Preferably, said producer cell line is suitable for producing antibodies for use in humans. Hence, said producer cell line is preferably free of pathogenic agents such as pathogenic micro-organisms. Most preferably, antibodies or functional equivalents consisting of human sequences are generated using at least one nucleic acid sequence or vector according to the invention.

An isolated or recombinant antibody producing cell capable of producing an antibody or a functional part, derivative and/or analogue thereof according to the invention is therefore also provided, as well as a method for producing an isolated, synthetic or recombinant antibody or functional part, derivative and/or analogue according to the invention, comprising providing a cell with a nucleic acid sequence or functional equivalent or vector according to the invention and allowing said cell to translate said nucleic acid sequence or functional equivalent or vector, thereby producing said antibody or functional part, derivative and/or analogue thereof.

An antibody producing cell is defined herein as a cell which is capable of producing and/or secreting antibody or a functional equivalent thereof, and/or which is capable of developing into a cell which is capable of producing and/or secreting antibody or a functional equivalent thereof. An antibody producing cell according to the invention is preferably a producer cell which is adapted to commercial antibody production. Preferably, said producer cell is suitable for producing antibodies for use in humans.

A method according to the invention preferably further comprises a step of harvesting, purifying and/or isolating said antibody or functional part, derivative and/or analogue thereof according to the invention. Obtained antibodies or functional equivalents according to the invention are preferably used in human therapy, optionally after additional purifying, isolation or processing steps.

Now that improved Respiratory Syncytial Virus-specific antibodies or functional equivalents according to the invention and nucleic acid sequences and vectors coding therefore have been provided, including human antibodies or functional equivalents, improved prophylactic and/or therapeutic applications have become available. RSV is counteracted by antibodies or functional equivalents according to the invention. An antibody or functional equivalent according to the invention is therefore particularly suitable for use as a medicine or prophylactic agent, optionally in combination with at least one other RSV-specific antibody known in the art. Preferably, antibodies or functional equivalents are used which consist of human sequences, or which have at most 5% of non-human sequences, in order to reduce the chance of adverse side effects when human individuals are treated. An isolated, synthetic or recombinant antibody or a functional part, derivative and/or analogue thereof or a nucleic acid sequence or functional equivalent thereof or a vector or a cell according to the invention for use as a medicament and/or prophylactic agent is therefore also herewith provided. When a nucleic acid or functional equivalent or vector according to the invention is administered, it will be translated in situ into an antibody or functional equivalent according to the invention. In a particularly preferred embodiment said antibody comprises antibody AM22, or a functional equivalent thereof. Said medicament or prophylactic agent is preferably used for counteracting or at least in part preventing an infection by RSV. Further provided is therefore an isolated, synthetic or recombinant antibody or a functional part, derivative and/or analogue thereof or a nucleic acid sequence or functional equivalent thereof or vector or cell according to the invention for use as a medicament and/or prophylactic agent for at least in part treating and/or preventing a disorder related to RSV. A medicament that comprises AM22 in combination with at least one other RSV-specific agent, preferably an antibody, known in the art, is particularly advantageous because with such combination a stronger immunogenic response to RSV is obtained and/or higher antibody specificity against RSV is reached. Further provided is therefore a combination of an isolated, synthetic or recombinant antibody or a functional part, derivative and/or analogue thereof or a nucleic acid sequence or functional equivalent thereof or vector or cell according to the invention and another, different RSV-specific agent, preferably an antibody or functional equivalent thereof, for use as a medicament and/or prophylactic agent. A combination according to the invention preferably comprises AM22 and an antibody selected from the group consisting of palivizumab, D25, AM14, AM16 and AM23. As said before, such combination is particularly suitable for at least in part treating or preventing a RSV-related disorder. Further provided is therefore a use of a combination according to the invention for the preparation of a medicament and/or prophylactic agent for at least in part treating and/or preventing a disorder related to RSV. A use of an isolated, synthetic or recombinant antibody or a functional part, derivative and/or analogue thereof or a nucleic acid sequence or functional equivalent thereof or vector or cell according to the invention for the preparation of a medicament and/or prophylactic agent for at least in part treating and/or preventing an RSV-related disorder is therefore also provided, as well as a method for at least in part treating or preventing a RSV-related disorder, the method comprising administering to an individual in need thereof a therapeutically effective amount of an isolated, synthetic or recombinant antibody or a functional part, derivative and/or analogue thereof according to the invention. In one preferred embodiment, a combination with at least one other RSV-specific agent, preferable another RSV specific antibody, is used. Said individual has preferably been diagnosed to be infected by RSV before treatment.

Said antibody preferably comprises antibody AM22, or a functional part thereof. Said at least one other RSV-specific antibody is preferably palivizumab, D25, AM14, AM16 or AM23. Most preferably a combination of AM22 and D25 is used.

In order to at least in part treat or prevent a disorder related to Respiratory Syncytial Virus, an antibody or functional equivalent according to the invention is preferably administered to an individual before an infection has taken place. Alternatively, an antibody or functional equivalent according to the invention is administered when an individual is already infected. Said antibody or functional equivalent is preferably administered to individuals with an increased risk of complications, such as for instance hospitalized individuals and/or individuals with compromised immunity. Also elderly people have an increased risk of RSV infection. Antibodies or functional equivalents according to the invention are preferably administered via one or more injections. Dose ranges of antibodies or functional equivalents according to the invention to be used in the prophylactic or therapeutic applications as described herein before are designed on the basis of rising dose studies in the clinic in clinical trials for which rigorous protocol requirements exist. Typical doses are between 0.1 and 10 mg per kg body weight. For prophylactic or therapeutic application antibodies or functional equivalents according to the invention are typically combined with a pharmaceutically acceptable carrier, diluent and/or excipient. Examples of suitable carriers for instance comprise keyhole limpet haemocyanin (KLH), serum albumin (e.g. BSA or RSA) and ovalbumin. In one preferred embodiment said suitable carrier comprises a solution like for example saline.

In yet another embodiment a nucleic acid or a vector encoding an antibody or functional equivalent according to the invention is used. As already described, upon administration of such nucleic acid or vector, antibodies or functional equivalents are produced by the host's machinery. Produced antibodies or functional equivalents are capable of at least in part preventing and/or counteracting Respiratory Syncytial Virus infection and/or the adverse effects of such infection. A nucleic acid sequence or functional equivalent or a vector according to the invention for use as a medicament and/or prophylactic agent is therefore also herewith provided. Further provided is a use of a nucleic acid sequence or functional equivalent or vector according to the invention for the preparation of a medicament and/or prophylactic agent for at least in part treating and/or preventing a RSV-related disorder.

Further provided is a pharmaceutical composition comprising an isolated, synthetic or recombinant antibody or a functional part, derivative and/or analogue thereof or a nucleic acid sequence or functional equivalent thereof or vector or cell according to the invention and a pharmaceutical acceptable carrier, diluent or excipient. Said pharmaceutical composition is preferably suitable for human use. In one preferred embodiment said antibody is AM22. In a further preferred embodiment said nucleic acid encodes AM22 or a functional equivalent thereof. In one embodiment said pharmaceutical composition further comprises at least one other RSV-specific antibody, preferably palivizumab, D25, AM14, AM16 and/or AM23.

The invention is further explained in the following examples. These examples do not limit the scope of the invention, but merely serve to clarify the invention.

REFERENCES

-   Chen Y, Wiesmann C, Fuh G, Li B, Christinger H W, McKay P, de Vos A     M, Lowman H B. Selection and analysis of an optimized anti-VEGF     antibody: crystal structure of an affinity-matured Fab in complex     with antigen. J Mol Biol. 1999; 293(4):865-81. -   Diehl S A, Schmidlin H, Nagasawa M, van Haren S D, Kwakkenbos M J,     Yasuda E, Beaumont T, Scheeren F A, Spits H. STAT3-mediated     up-regulation of BLIMP1 Is coordinated with BCL6 down-regulation to     control human plasma cell differentiation. J Immunol. 2008;     180(7):4805-15. -   Jaleco A C, Stegmann A P, Heemskerk M H, Couwenberg F, Bakker A Q,     Weijer K, Spits H. Genetic modification of human B-cell development:     B-cell development is inhibited by the dominant negative helix loop     helix factor Id3. Blood. 1999; 94(8):2637-46. -   Kabat E A, Wu T T. Identical V region amino acid sequences and     segments of sequences in antibodies of different specificities.     Relative contributions of VH and VL genes, minigenes, and     complementarity-determining regions to binding of antibody-combining     sites. J Immunol. 1991; 147(5):1709-19. -   Kwakkenbos M J, Diehl S A, Yasuda E, Bakker A Q, Van Geelen C M M,     Lukens M V, Van Bleek G M, Widjojoatmodjo M N, Bogers W M J M, Mei     H, Radbruch A, Scheeren F A, Spits H and Beaumont T. Generation of     stable monoclonal antibody-producing BCR⁺ human memory B cells by     genetic programming. Nat Med. 2009 In press. -   Shvarts A, Brummelkamp T R, Scheeren F, Koh E, Daley G Q, Spits H,     Bernards R. A senescence rescue screen identifies BCL6 as an     inhibitor of anti-proliferative p19(ARF)-p53 signaling. Genes Dev.     2002; 16(6):681-6. -   Scheeren F A, Naspetti M, Diehl S, Schotte R, Nagasawa M, Wijnands     E, -   Gimeno R, Vyth-Dreese F A, Blom B, Spits H. STAT5 regulates the     self-renewal capacity and differentiation of human memory B cells     and controls Bcl-6 expression. Nat Immunol. 2005; 6(3):303-13. -   Ternette N, Tippler B, Uberla K, Grunwald T. Immunogenicity and     efficacy of codon optimized DNA vaccines encoding the F-protein of     respiratory syncytial virus. Vaccine. 2007; 25(41):7271-9. -   U.S. Pat. No. 5,624,821 -   U.S. Pat. No. 5,739,277 -   U.S. Pat. No. 6,277,375 -   U.S. Pat. No. 6,737,056 -   U.S. Pat. No. 6,821,505 -   U.S. Pat. No. 7,083,784 -   U.S. Pat. No. 7,317,091 -   U.S. Pat. No. 7,217,797 -   U.S. Pat. No. 7,276,585 -   U.S. Pat. No. 7,355,008 -   US 2002/0147311 -   US 2004/0002587 -   US 2005/0215768 -   US 2007/0135620 -   US 2007/0224188 -   US 2008/0089892 -   WO 94/29351 -   WO 99/58572 -   WO 2008/147196

FIGURE LEGENDS

FIG. 1. AM22, a novel fully human monoclonal antibody, neutralizes the RSV A2 virus very efficiently on Hep2 cells compared to palivizumab.

FIGS. 2A and 2B. AM22 heavy and light chain nucleotide sequences and amino acid sequences.

FIGS. 3A-3D. Human anti-RSV monoclonal antibodies recognize conformational epitopes on the Fusion (F) protein of RSV as determined by ELISA and FACS staining. FIG. 3A shows binding of the antibodies to EL-4 cells infected with Vesicular Stomatitis Virus (VSV) which was pseudotyped with the RSV F or RSV G protein. FIG. 3B shows binding of the anti-RSV F antibodies to ELISA plates that were coated with a lysate of RSV infected HEp2 (left panel) or with Ni-NTA HisSorp Plates (Qiagen) coated with recombinant HIS tagged F protein (right panel). Antibody binding to the F protein is detected with HRP-conjugated IgG detection antibody (dilutions 1:2500, Jackson). FIG. 3C shows binding of the recombinant RSV F Long strain containing a poly HIS tag to the original B cell clones, binding to the BCR is detected with an anti-pentaHIS antibody. In FIG. 3D we show the intracellular binding of the human anti-RSV antibodies to 293T cells transfected with a recombinant RSV F construct containing a trimerization domain (ILZ domain).

FIGS. 4A-4C. RSV challenge in Cotton rats prophylatically treated with human immunoglobulins. (A) shows the retrieval of human IgG1 from serum at day 1 and day 5 after intramuscular administration of indicated doses of antibodies in Cotton rats. FIG. 4B shows the RSV load in the lungs of Cotton rats treated with the indicated antibodies 24 hours before infection with RSV-X. RSV load was determined 5 days after infection with TCID₅₀ culture. Experiments were performed twice with four to six individual animals per treatment group. Lung pathology was studied in the same animal groups FIG. 4C, indicated is the average lung pathology of AM22 and palivizumab, see also table 2.

EXAMPLES Example 1. B Cell Culture, Immortalization and Selection

Methods

B cells were immortalized and cultured as described before (Scheeren F A, et al. (2005) Nat Immunol 6: 303-313; Diehl S A, et al. (2008) J Immunol 180: 4805-4815 and Kwakkenbos M J, et al. (2009) Nat Med in press). In brief, we isolated B cells from peripheral blood (Sanquin, Amsterdam, The Netherlands) by Ficoll separation, CD22 MACS microbeads (Miltenyi Biotech) and subsequently cell sorting for CD19⁺CD3-CD27⁺IgM-IgA- (IgG memory cells) on a FACSAria (Becton Dickinson). The use of these tissues was approved by the medical ethical committees of the institution and was contingent on informed consent. Retroviral transduced B cells, were maintained at 2×10⁵ cells ml⁻¹ in IMDM supplemented with recombinant mouse IL-21 (25 ng ml⁻¹, R&D systems) and co-cultured with γ-irradiated (50Gy) mouse L cell fibroblasts stably expressing CD40L (CD40L-L cells, 10⁵ cells ml⁻¹) for 36 hours. The BCL6 and Bcl−xL retroviral constructs were described previously (Shvarts A, et al. (2002) Genes Dev 16: 681-686 and Jaleco A C, et al. (1999) Blood 94: 2637-2646)) and were cloned into the LZRS retroviral vector and transfected in Phoenix packaging cells as described before and added to the stimulated B cells (Shvarts A, et al. (2002) Genes Dev 16: 681-686 and Scheeren F A, et al. (2005) Nat Immunol 6: 303-313). Transduced B cells were maintained in IMDM, in the presence of recombinant IL-21 and CD40L-L cells for prolonged periods of time. Given the relatively high amounts of secreted antibodies by BCL6+Bcl−xL-transduced B cells we examined whether we could select antigen-specific B cells on the basis of secretion of specific antibody. BCL6+Bcl−xL transduced memory B cells of a healthy donor were seeded at 100 cells/well and expanded with CD40L-L cells and IL-21. After 2 weeks of culture, supernatants were harvested and screened for the presence of RSV-neutralizing antibodies in a microneutralization experiment. Of 384 cultures (100 cells/well), 31 prevented RSV A2 infection of HEp2 cells. Besides the four microcultures from which D25, AM14, AM16, and AM23 were subcloned by limiting dilution, we next obtained AM22. AM22 has a median half maximum inhibitory concentrations (IC50) against the RSV-A2 virus of 1.15 ng ml⁻¹ (FIG. 1).

To obtain the sequence of the heavy and light chain of the immunoglobulin locus of AM22, we isolated total RNA with the RNeasy® mini kit (Qiagen), generated cDNA, performed PCR and cloned the heavy and light chain variable regions into the pCR2.1 TA cloning vector (Invitrogen). To rule out reverse transcriptase or DNA polymerase induced mutations, we performed several independent cloning experiments. To produce recombinant AM22 mAb we cloned AM22 heavy and light variable regions in frame with human IgG1 and Kappa constant regions into a pcDNA3.1 (Invitrogen) based vector and transiently transfected 293T cells. We purified recombinant AM22 from the culture supernatant with Protein A.

Results

Previously we developed four potent conformational dependent anti-RSV antibodies, named AM14, AM16, AM23 and D25. These antibodies have been described in WO 2008/147196 and by Kwakkenbos M J et al. (2009) Nat Med in press. From the same donor we also discovered AM22, which recognized the RSV virus even more efficiently compared to the other antibodies as is evident from an IC₅₀ of 1.15 ng ml⁻¹ against the RSV A2 virus (table 1 and FIG. 1). The amino acid sequence of the VH and VL chain of AM22 revealed that this antibody is different from the other antibodies (FIG. 2).

Example 2. In Vitro Binding Experiments

To further determine the antigen specificity of the AM22 antibody we performed in vitro binding experiments to reveal whether the protein recognized the RSV F or G protein and in what type of conformation.

Methods

(1) FACS Staining of RSV G or F Protein

Virus stock of wild type and recombinant Vesicular Stomatitis Virus (VSV) expressing RSV-G protein (VSV-G) or RSV-F protein (VSV-F) (experiments were performed by M. Lukens at WKZ, Utrecht and VSV viruses were kindly provided by J. S. Kahn and J. K Rose, Yale University School of Medicine) were prepared on BHK cells grown in DMEM containing 5% FCS, penicillin/streptomycin and 50 μM 2-mercapto-ethanol. VSV infection was performed on EL-4 cells that were cultured in Iscove's Modified Dulbecco's medium (IMDM, Gibco, Invitrogen) supplemented with 5% FCS, penicillin/streptomycin and 50 μM 2-mercapto-ethanol. EL-4 cells infected with the VSV virus variants were incubated with recombinant antibody and subsequently stained with mouse-anti-human PE (FIG. 3A).

(2) RSV ELISA

Plates were coated with lysate of RSV infected HEp-2 cells in PBS for 1 hour at 37° C. or o/n at 4° C. and washed in ELISA wash buffer (PBS, 0.5% Tween-20). Plates were blocked by incubation with 4% milk in PBS, before the anti-RSV antibodies or polyclonal goat anti-RSV (Biodesign) in combination with enzyme-conjugated anti-IgG antibodies were added (dilutions 1:2500 for HRP-conjugated anti-IgG (Jackson). TMB substrate/stop solution (Biosource) was used for development of the ELISAs (FIG. 3B left panel). In addition to the lysate of RSV-A2 infected HEp-2 cells, HIS-tagged F protein from RSV Long strain (kindly provided by Frank Coenjaerts, UMCU, Utrecht based on Ternette N, et al, (2007) Vaccine 25: 7271-7279) was used to coat Ni-NTA HisSorp Plates (Qiagen) (FIG. 3B right panel). The binding of the RSV F antibodies was detected with HRP-conjugated IgG detection antibody (dilutions 1:2500, Jackson). In another setting the original B cell clones were used for FACS analysis (FIG. 3C). The B cells were incubated with the recombinant HIS tagged F protein and binding to the BCR was detected with a labeled anti-penta HIS antibody ALEXA fluor 647 (Qiagen).

(3) RSV Trimers

In addition to the recombinant RSV long strain derived F protein we created RSV A2 F trimers by inserting the open reading frame of F into a construct which is fused to an isoleucine zipper domain followed by 8 HIS repeats (ILZ-8×HIS). Protein constructs were transiently expressed in 293T cells and detected by using an intracellular staining protocol using the Fix Perm kit of BD (FIG. 3D).

Results

All antibodies recognized the RSV-F protein when expressed by recombinant VSV (FIG. 3A). Furthermore, except for AM16, recognition was dependent on the presence of conformational epitopes in the RSV-F protein since they did not recognize a lysate of RSV infected HEp-2 cells (FIG. 3B left panel). Also purified HIS-tagged recombinant RSV-F Long strain protein was not recognized by D25, AM14, AM22 and AM23 when tested in a direct ELISA (FIG. 3B right panel). However when the original stable BCR expressing B cell lines were incubated with this non-purified culture supernatant of the HIS tagged RSV-F protein we did observe binding to the B cell clones AM16, AM23 and less strong to D25 (FIG. 3C). The protein in this non-purified culture supernatant possibly contains a fraction of RSV F trimers that do bind the BCR but are only captured as monomers on the HisSorp Plates. However still no RSV-F protein capture was observed to the BCRs of the AM14 and the AM22 B cell lines (FIG. 3C). Thus AM14 and AM22 bind to different epitopes. Possibly a low percentage of protein F homotrimers or dimers was present in the untreated culture supernatant of the F protein producing cell line. These more native F conformations may express the epitopes recognized by AM23 and D25, which were lost in the denaturizing conditions of the ELISA procedures. Interestingly when we performed an intracellular staining on 293T cells transfected with the RSV trimerization construct containing the ILZ-8×HIS sequence we found that AM22 did recognize RSV F (FIG. 3D), however AM14 still did not recognize this protein structure. Thus AM22 is unique since it recognizes a conformation of the RSV-F protein that is not present in denaturing conditions and thus is not present in the monomeric form of the protein. Only when the RSV F proteins are forced to stay together and form trimers then we can detect F binding by the AM22 antibody, a conformation that is present on virus particles and thus explain the high neutralizing potency of AM22.

Example 3. In Vivo Potency Experiments

To study the in vivo potency of the AM22 monoclonal antibody we performed Cotton rat experiments.

Methods

Pathogen free 7-9 week-old Cotton rats (Sigmodon hispidus, Harlan Laboratories, Nederland) were anesthetized with isoflurane and given 0.1 ml of purified antibody by intramuscular (i.m.) injection at doses of 2.0 or 0.4 mg kg⁻¹ for the control antibody, palivizumab, AM22, AM23 and D25, while AM14 was administered at 0.4 and 0.1 mg kg⁻¹. Twenty-four hours later, animals were anesthetized, bled for serum hIgG determination and challenged by intranasal instillation of 106 TCID₅₀ RSV-X (100 μl). Five days later animals were sacrificed and their lungs were harvested. Lung virus titers were determined and the lowest limit of detection was 2.1 log₁₀ TCID₅₀ g⁻¹. The Animal Experiment Committee of the Netherlands Vaccine Institute approved all procedures involving Cotton rats.

Results

The anti-RSV antibody panel, except AM16, was tested in Cotton rats. Animals were prophylactically treated with 2.0 or 0.4 mg kg⁻¹ of monoclonal antibodies before RSV-X, a primary RSV A isolate, was intra-nasally administered. Due to relatively low antibody production, the AM14 antibody was administered at 0.4 and 0.1 mg kg⁻¹. The level of recovered human IgG from Cotton rat sera at day 1 (day of virus inoculation) and day 5 (day of sacrifice) was in the same range for all antibodies and the decline of antibodies in time was comparable (FIG. 4A).

The retrieval of RSV virus from the lungs of sacrificed animals was strongly reduced in all animal groups treated with 2.0 mg/kg of immunoglobulin compared to the control group (FIG. 4B). Animals treated with 0.4 mg kg⁻¹ palivizumab and AM23 showed significant virus replication, while in the AM14 and D25 groups one out of 6 animals showed detectable virus replication. No virus could be retrieved from animals treated with AM22. These results demonstrate that AM22, that specifically recognized conformational epitopes on the RSV F protein, harbors strong in vivo neutralizing capacities.

Analysis of Lung Pathology of RSV Challenged Cotton Rats

From each Cotton rat at day 5 after i.n. RSV infection the left lung was removed and fixed with formalin. Lung damage was classified between 0-5 for three individual markers: 1) hypertrophy of bronchus and bronchioli epithelia, 2) inflammation surrounding bronchus and bronchioli (peribronchiolitis) and 3) inflammation in the alveoli (alveolitis). The average sum of the scores of all animals in one group created the pathology index (maximum score 15) (FIG. 4c , table 2). Lung pathology after RSV infection was significantly reduced in animal groups treated with high doses of immunoglobulin (2 mg kg⁻¹) (table 3). However only in the AM14, AM22 and AM23 groups the pathology was significantly reduced at lower concentrations (0.4 mg kg⁻¹). While a complete absence of pathology was seen in 3 out of 5 animals treated with AM22 and AM23 at 2 mg kg⁻¹, at 0.4 mg kg⁻¹ complete protection was detected in 2 or 1 out of 6 animals in the AM14 and AM22 groups respectively (table 3).

When combining the results of examples 1, 2 and 3 it is concluded that AM22 has certain advantages. AM22 demonstrates the lowest IC₅₀ value, meaning that with a lower amount of AM22 similar prophylactic or therapeutic effects are achieved as compared with other antibodies. AM22 recognizes a different epitope of the RSV F protein than the other antibodies and therefore can be used in combination with one of the other antibodies to achieve a stronger immunogenic response to RSV and higher antibody specificity against RSV. Finally, treatment of Cotton rats with AM22 resulted in nearly complete inhibition of virus replication with potential complete absence of pathology in these Cotton rats.

Example 4. Affinity of AM22 for the RSV F Protein

Determining the affinity constant and specificity of binding between the RSV F protein and AM22 is preferred to establish the prophylactic, therapeutic and diagnostic value of the antibody. This is a challenging feature since the antibody affinity has to be determined for an oligomeric protein structure. Usually affinity constants are determined against immobilized agents that are captured on a chip. However protein F captured on a chip would not be recognized by the AM14, AM22, AM23 and D25 antibodies.

Method

“Binding affinity” generally refers to the strength of the sum total of the noncovalent interactions between a single binding site of a molecule (e.g., an antibody) and its binding partner (e.g., an antigen). The affinity of a molecule X for its partner Y can generally be represented by the equilibrium dissociation constant (Kd), which is calculated as the ratio k_(off)/k_(on). Affinity can be measured by common methods known in the art, such as a surface plasmon resonance (SPR) assay. Affinities (KD), on-rates (ka) and off-rates (kd) will be measured by SPR analysis with the IBIS-iSPR instrument at IBIS Technologies BV (Hengelo, the Netherlands). Briefly, anti-RSV antibodies are immobilized and purified RSV F protein (containing penta-HIS) is diluted and rate and affinity constants are measured by injection of at least three serial dilutions of the protein.

Another set up in the IMIS-iSPR machine is to immobilize 1) an anti-penta HIS antibody on which the F-penta HIS protein is coupled or 2) F-penta HIS protein is directly immobilized on the chip and then samples on the chip are incubated with the AIMM antibodies to determine the affinity constants.

TABLE 1 RSV neutralizing activity of purified IgGs. RSV A2^(a) palivizumab 152 D25 1.28 AM14 2.09 AM16 78.7 AM22 1.15 AM23 4.18

The IC₅₀ (ng/ml) values of the selected anti-RSV IgGs were determined with standard TCID₅₀ culture assay on HEp2 cells with the RSV A2 virus.

TABLE 2 Cumulative pathology score in Cotton rats. Pathology score antibody mg/kg (SEM) P values Palivizumab 2.0 3.20 (0.4) 0.0005 Palivizumab 0.4 5.40 (0.8) <0.05 D25 2.0 3.40 (0.4) 0.0005 D25 0.4 5.83 (1.0) 0.05 AM14 0.4 4.20 (0.8) 0.05 AM14 6.1 3.67 (1.2) 0.05 AM22 2.0 2.75 (0.8) 0.0005 AM22 0.4 4.00 (0.9) <0.05 AM23 2.0 2.40 (0.2) 0.0005 AM23 0.4 3.50 (0.9) <0.05 Ctrl IgG1 2.0 8.80 (1.1) N.A. MOCK N.A. 1.80 (0.4) 0.0005

Cumulative pathology score of the lungs of Cotton rats, treated 24 hour before RSV infection with the indicated antibodies. Lung specimens obtained 5 days after infection were evaluated by a pathologist randomly. Lungpathology was classified with scores between 0-5 for three individual markers: 1) hyperthropy of bronchus and bronchioli epithelia, 2) peribronchiolitis and 3) alveolitis. Average pathology score (maximum score 15) with standard error of the mean (SEM) and statistical differences in relation to Ctrl IgG1 group was calculated with the 2-sided Wilcoxon test. Experiments were performed twice with four to six individual animals per treatment group. N.A. not applicable.

TABLE 3 Prevention of pathology in Cotton rats. Significant reduction antibody mg/kg in pathology No pathology Palivizumab 2 5/5 1/5 Palivizumab 0.4 3/5 0/0 D25 2 5/5 0/5 D25 0.4 2/6 0/6 AM14 0.4 5/6 2/6 AM14 0.1 4/5 0/5 AM22 2 5/5 3/5 AM22 0.4 5/6 1/6 AM23 2 5/5 3/5 AM23 0.4 5/6 0/6

Number of animals with significant reduction in/or absence of lung pathology at day 5 during RSV-X infection. Experiments were performed twice with four to six individual animals per treatment group. 

The invention claimed is:
 1. A method for treating and/or preventing a RSV-related disorder, the method comprising administering to an individual in need thereof a therapeutically effective amount of an antibody, or functional part thereof, wherein the antibody or functional part thereof specifically binds to a Respiratory Syncytial Virus (RSV) F protein and comprises: a heavy chain CDR1 sequence comprising the sequence KLSIH (SEQ ID NO:4), a heavy chain CDR2 sequence comprising the sequence GYEGEVDEIFYAQKFQH (SEQ ID NO:8), a heavy chain CDR3 sequence comprising the sequence LGVTVTEAGLGIDDY (SEQ ID NO:12), a light chain CDR1 sequence comprising the sequence RASQIVSRNHLA (SEQ ID NO:20), a light chain CDR2 sequence comprising the sequence GASSRAT (SEQ ID NO:24), and a light chain CDR3 sequence comprising the sequence LSSDSSI (SEQ ID NO:28).
 2. The method of claim 1, the antibody or functional part thereof having a heavy chain sequence comprising a sequence which is at least 70% identical to the sequence (SEQ ID NO: 16) QVQLVQSGAEVKKPGATVKVSCKISGHTLIKLSIHWVRQAPGKGLEWMGG YEGEVDEIFYAQKFQHRLTVIADTATDTVYMELGRLTSDDTAVYFCGTLG VTVTEAGLGIDDYWGQGTLVTVSS

and/or having a light chain sequence which is at least 70% identical to the sequence (SEQ ID NO: 32) EIVLTQSPGTLSLSPGERATLSCRASQIVSRNHLAWYQQKPGQAPRLLIF GASSRATGIPVRFSGSGSGTDFTLTINGLAPEDFAVYYCLSSDSSIFTFG PGTKVDFK.


3. The method of claim 1, wherein the antibody, or functional part thereof, comprises an IgG1 heavy chain.
 4. The method of claim 1, wherein the antibody, or functional part thereof, comprises a Fc region comprising a modification at one or more positions selected from the group consisting of 234, 235, 236, 237, 238, 239, 240, 241, 243, 244, 245, 247, 251, 252, 254, 255, 256, 262, 263, 264, 265, 266, 267, 268, 269, 279, 280, 284, 292, 296, 297, 298, 299, 305, 313, 316, 325, 326, 327, 328, 329, 330, 331, 332, 333, 334, 339, 341, 343, 370, 373, 378, 392, 416, 419, 421, 440 and 443 as numbered by the EU index of Kabat, said modification comprising an amino acid substitution, and/or an amino acid insertion, and/or an amino acid deletion.
 5. The method of claim 4, wherein the Fc region modification comprises amino acid substitutions at amino acid positions 252, 254, and/or
 256. 6. The method of claim 5, wherein the amino acid substitution at amino acid position 252 is a substitution with tyrosine, the amino acid substitution at amino acid position 254 is a substitution with threonine, and/or the amino acid substitution at amino acid position 256 is a substitution with glutamic acid.
 7. The method of claim 1, wherein the antibody or functional part thereof is administered to the individual before infection with RSV.
 8. The method of claim 1, wherein the antibody or functional part thereof is administered to the individual after infection with RSV.
 9. The method of claim 1, wherein the individual is at an increased risk of complications from an RSV infection.
 10. The method of claim 9, wherein an increased risk of complications from an RSV infection comprises premature birth, otherwise healthy but younger than six weeks of age, elderly, chronic lung disease, congenital heart disease, hospitalized, or with compromised immunity.
 11. The method of claim 1 further comprising administering palivizumab, AM14, AM16, AM23, and/or D25.
 12. The method of claim 1, further comprising administering at least one other RSV-specific antibody.
 13. The method of claim 1, wherein the antibody or functional part thereof comprises: a heavy chain sequence comprising the amino acid sequence of SEQ ID NO:16; or a light chain sequence comprising the amino acid sequence of SEQ ID NO:32; or a heavy chain sequence comprising the amino acid sequence of SEQ ID NO:16 and a light chain sequence comprising the amino acid sequence of SEQ ID NO:32.
 14. The method of claim 1, wherein the antibody or functional part thereof comprises a humanized antibody.
 15. The method of claim 1, wherein the antibody or functional part thereof comprises a human antibody.
 16. The method of claim 1, wherein the antibody or functional part thereof comprises a human IgG1 heavy chain.
 17. The method of claim 13, wherein the antibody or functional part thereof comprises a human IgG1 heavy chain.
 18. The method of claim 17, wherein the antibody, or functional part thereof, comprises a Fc region comprising a modification at one or more positions selected from the group consisting of 234, 235, 236, 237, 238, 239, 240, 241, 243, 244, 245, 247, 251, 252, 254, 255, 256, 262, 263, 264, 265, 266, 267, 268, 269, 279, 280, 284, 292, 296, 297, 298, 299, 305, 313, 316, 325, 326, 327, 328, 329, 330, 331, 332, 333, 334, 339, 341, 343, 370, 373, 378, 392, 416, 419, 421, 440 and 443 as numbered by the EU index of Kabat, said modification comprising an amino acid substitution, and/or an amino acid insertion, and/or an amino acid deletion.
 19. The method of claim 18, wherein the Fc region modification comprises amino acid substitutions at amino acid positions 252, 254, and/or
 256. 20. The method of claim 19, wherein the amino acid substitution at amino acid position 252 is a substitution with tyrosine, the amino acid substitution at amino acid position 254 is a substitution with threonine, and/or the amino acid substitution at amino acid position 256 is a substitution with glutamic acid. 